Medicare Advantage Plans California

Medicare Advantage Plans California

Part C

California Medicare Advantage plans are also known as Part C. These plans are different from Original Medicare and save some folks a lot of money. If you choose this option, you will continue to have the same full rights as those on Original Medicare. Your Advantage plan will be responsible for you and making sure you get all your benefits. Medicare Advantage plans will always include all the same services that Original Medicare would and many include extra benefits such as preventive care, hearing aids, dental care and eye exams.

Medicare Advantage plans California renew on a yearly basis with Medicare. Medicare pays the Advantage plan an amount each month per member. The amount paid is adjusted each year and is different from one county in California to the next. That’s why they can offer a plan with low to no monthly premium and in some counties very few copays.

What do Medicare Advantage plans in California cost?

It does vary by county, but some Advantage plans have a monthly premium. The range we are seeing in 2013 is somewhere between $206 and $0. Most plans also have copayments for doctor office visits and other services. There are a few plans that have a deductible and all have a maximum that you would need to pay out of your pocket or MOOP.

Can I just join a plan without Part A & B?

You have to signup for Medicare Parts A and B first if you want to enroll in a Medicare Advantage plan and you will need to keep paying for Part B.

Do I need to worry about preexisting conditions?

You will not be declined enrollment in a Medicare Advantage plan if you have a preexisting condition except for those who have ESRD. In case you didn’t know, this when someone has permanent kidney failure. In the case where one is already enrolled in an Advantage plan and then diagnosed with ESRD the plan is not allowed to dis enroll them.

At what times can I join?

You can enroll in a Medicare Advantage plans California at several different times of the year. The most common one is the Initial Coverage Election Period (ICEP). That’s the time that starts 3 months before you turn 65, your birth month, and the 3 months following your birth month. The Annual Election Period or AEP is another time you can join or change your plan. There are Special Election Period’s(SEP) when you can signup at anytime of the year like if you’ve moved from one state to another or even to another county in California.

Are prescriptions covered?

Some plans offer prescription coverage also known as Part D, these plans are called MAPD’s. The other plans that do not have drug coverage are called MA plans. Should you decide to enroll in an MA plan it will not be possible to get a separate Part D unless you join a PFFS plan. Learn about Part D here.

What is an HMO?

“HMO” stands for Health Maintenance Organizations. You will need to use only doctors and hospitals that accept the particular HMO plan that you have. These plans require you to pick a primary care doctor, also called a PCP, who acts as the “gatekeeper”. If you need to care that requires a specialist then you must ask your PCP for a referral. This is not required in an emergency if urgent care is needed.

You will need to select new doctors if the doctors you currently see are not in the HMO’s network. If there is a particular doctor you would like to see that doesn’t take your HMO plan then this doctor will not be covered and trying to use your original Medicare card will not work either. The costs for services from non-network doctors for routine care will be 100% your responsibility. Just know that providers can end their contract with an HMO at any time.

Are there plans for those with Special Needs?

Special Needs Plans or SNPs are available for certain people. An SNP might be available for those who have Medicare and also receive Medi-Cal, or those with chronic illnesses. SNPs are designed to make specialized services available to those who really need it the most. SNPs always include prescription coverage, and many have extra benefits than those available with Original Medicare. There are SNPs available only in specific counties.

Thing to consider before making a choice

Are there certain doctors you want to be able see? Are they in the plan’s network? Do they accept other plans? If they do, which ones are they? What will it cost if you choose to see doctors outside your plan’s network? Which prescription drugs are covered and what are the copays? Some plans do not offer prescription drug benefits. Each plan has a formulary that will give you the cost of each medication. Just call 1-888-806-3299 and we will help you choose the right Medicare Advantage plans California.

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